Healthcare Provider Details

I. General information

NPI: 1720996085
Provider Name (Legal Business Name): AUSTIN BLANKENSHIP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7326 COLLEGE ST
IRMO SC
29063-2901
US

IV. Provider business mailing address

6128 EDMUND HWY
LEXINGTON SC
29073-8182
US

V. Phone/Fax

Practice location:
  • Phone: 844-973-6159
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number7902
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: